Lay Summary (Englisch)

Lead

People in prison are not free to choose how and where they die. This means that the issue of dying with dignity requires special attention in the prison setting. This study examines what it means to die in prison and what ethical, legal and security-related issues are important.

Lay summary

BackgroundUnder the law, persons in prison are supposed to have the same access to an equivalent range of services, including medical care, as the rest of the population. The majority of the issues and problems related to end-of-life in the general population are the same in the prison setting. But it must be considered that the conditions and processes connected with the end-of-life in prisons present a number of hurdles. These make meeting the demands of care and pain relief in the setting of incarceration and punishment more difficult. What is more, Swiss prisons house a steadily growing number of older persons. Also, the trend is for stricter and longer sentences, as can be seen in changes in prison sentence practice and in the new option of the lifelong detention. This increases the number of persons who will die in prison. Ongoing discussion about good dying and palliative care shows that precisely those persons who cannot choose how and where they die require special attention.

AimUsing ethnographic methods, case studies and legal analyses, this study examines end-of-life issues from the perspective of different actors and at different institutional levels in the Swiss penitentiary system. The aim is to analyse the legal and institutional bases and current practice in dealing with the end-of-life and dying in different prisons. Further, the research team will reconstruct specific cases from the perspective of the persons involved (inmates, family members, staff, other institutional actors) and document emerging institutional solutions and examples of good practice.

SignificanceThis study takes up a new and growing social problem. It deals with institutional handling issues and good practice with regard to the end-of-life in the context of the Swiss penitentiary system and will thus serve the interests of both the practical and the research realm.

Abstract

What a good end-of-life (EOL) means, is a particularly relevant question in the context of confinement and prison. Current laws and regulations demand access to equal treatment and care for those held in custody as for the rest of the population. Most of the questions and issues raised by EOL for those living in liberty also apply to the correctional setting. However, the institutional particularities and logics of the prison create unique barriers and make it difficult in practice to reconciliate concerns in regard to EOL - like care and comfort - with the mandate of corrections - confinement and punishment. In the Swiss prison system, the number of elderly inmates is growing in absolute and relative terms: First, there is a general demographic trend towards an ageing society. Because of the particularity of the prison population (high-risk lifestyles, health problems, negative effects of long-term imprisonment) one may observe a process of “hyper-aging”. Second, people increasingly offend at a later moment in their life. Third, a trend to longer sentences may be observed as an effect of a punitive turn. Fourth, since 2007 the Swiss penal code makes it legal to keep people in confinement for an undetermined duration or for life and therefore some inmates are bound to spend their EOL in prison. Finally, in the light of the recent discussion on palliative care and good dying in society at large, there is a special need to take people into account who die in settings they have not chosen freely and where their choices concerning how and where to die are restricted.Within the prison system, questions on how to respond appropriately to this phenomenon have been raised and discussed, but have scarcely been addressed scientifically. Thus, this project focuses on EOL practices from the perspective of different actors, across the Swiss prison system, and on different levels (the system as a whole, the single prison, and individuals or groups within the prison). In a first step the legal and institutional frame will be analysed so as to understand the context; in a second step, the institutions themselves, their logics and the scope of the phenomenon (EOL in prison) will be examined; the third step will involve exploring and documenting perspectives of different actors; finally, attention will be directed towards emerging institutional responses and arrangements and to questions of good practice. Empirical material will be collected by means of ethnographic and case study methods, involving on-site research within the institutions, interviews and documents. Particular attention will be paid to institutional arrangements, actors and their perspectives, practices and experiences, as well as responsibilities. The research is explorative in orientation and holistic in its approach. It is actor-oriented and focused on institutional ethnography. The project responds to a new and increasing social problem; it aims at producing knowledge in a field that has been until today scarcely studied and will represent a first insight from a Swiss perspective. The project is already the fruit of collaboration between various institutions and aims at outlining “good governance” and “good practice” in the field (prison) and on the topic (EOL). It responds both, to the need of practitioners, as well as to the interest of science.